Manual Therapy is any intervention where the clinician manipulates the soft tissue. This includes massage, myofacial release, trigger point therapy, etc.

The type of technique used depends on the area, the thickness/type of the tissue and how the patient tolerates the treatment. The choice of treatment should be a conversation between the patient and clinician and based on the presentation of the injury.

Massage is using your hands to manipulate skin, muscle, and other connective tissue. The goal is to improve the quality, function and set the environment for healing. There are different techniques for different outcome that range from feel good/relaxing to deep/targetted to a specific tissue and then middle of the road for recovery/general performance. My focus is typically on the latter two examples.

Typically the first portion of a massage will be pretty light and broad to find trouble areas and start to narrow down our treatment targets. The pressure will be moderate and exploring through the length/bredth of the muscle/joint. Typically The strokes will move along with the direction of the fibers.

Second, the focus will be on the area of concern AND should also work the areas that contribute to the issue. These strokes can go along or across the direction of the muscle. They will be targetted to manipulate the tissue into better mobility. This is where the focus of the treatment will be.

Muscles as a whole, as well as the smaller partitions with in the muscles, are surrounded by fascia. Imagine saran wrap around all of the different structures. Saran wrap clings, sticks, and doesn't stretch well just like fascia. It can become stiff and cause sticking between different structures which can hinder proper movement.

This techniqe typically involves pinning a trouble spot then lengthening/shortening the involved muscle. It can be manual by a clinician or the patient (if they can reach) or done using a ball/roller/bar/etc. By doing this we hope to seperate the layers of fascia from each other and/or the muscle.

There are multiple advanced techniques for this, but they all focus around these concepts.

Trigger point is typically a single point of pressure right on the point of tightness/pain. This often relies on "ischemic compression" which means its cutting off blood flow to the area. If there isn't blood flow then the muscle doesn't have the fuel to contract. If it doesn't have fuel then it can't contract.

If the treatment is done correctly then the tightness should feel looser. The area should move better and there should be less resistance at the end range.
I don't typically lean in to the method for 2 reasons- 1) it can be uncomfortable & 2) there are treatments that I trust more. This technique can work but I have had more targetted relief with a higher comfort level for the patient. Sometimes though, it can be a good finisher for the session.

Manual therapy is a great way to address soft tissue restriction. I love all aspects of it and they each have their place. The art of treatment comes in how and when we apply it. A massage is great, targeted soft tissue treatment has fixed many a problem, however, how is it being integrated and what preceeds/follows the treament? That is what makes it successful.